Journal of Family & Reproductive Health

Psychosocial Prenatal Interventions for Teenage Pregnant: A Systematic Review

Simin Montazeri — 2025-08-01

Objective: Adolescent pregnancy is a pressing public health issue that significantly impacts the health and well-being of young mothers and their children. This systematic review evaluates the effectiveness of psychosocial prenatal interventions for pregnant adolescents, aiming to identify strategies that enhance maternal and neonatal outcomes.

Materials and methods: Systematic comprehensive literature search was conducted across PubMed, Web of Science, Scopus, Cochrane, Science Direct, Google Scholar, and Grey Literature. Studies published from 1996 to January 2023 were included if they focused on pregnant adolescents aged
10-22 years and employed randomized controlled trial (RCT) designs. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias 2 tool.

Results: Out of 2,450 articles screened, 22 studies met the inclusion criteria, revealing diverse interventions categorized into six main types: antenatal/postnatal educational programs, psychological interventions, home visits, partner support, and social support interventions. Findings indicated that these psychosocial interventions significantly improved maternal mental health, increased prenatal care utilization, and enhanced perinatal outcomes. However, the review highlighted the need for more rigorously designed studies to establish definitive conclusions regarding the most effective intervention strategies.

Conclusion: Results show Educational programs focusing on antenatal and postnatal care effectively enhance knowledge, reduce substance abuse, and boost breastfeeding confidence, leading to better pregnancy outcomes. While psychosocial interventions have improved mental health and school attendance. Home visiting programs have positively impacted maternal well-being and parenting skills. Group prenatal care (GPNC) is beneficial, especially for high-risk adolescents, by combining health evaluations with group education and support. Integrating psychosocial support into prenatal care models can help reduce health disparities among adolescent populations.

A Human Rights-Based Approach to Health in Assisted Reproductive Care in Spain

Rocío Paricio-del-Castillo — 2025-08-01

Objective: Assisted reproductive techniques (ART) have evolved significantly since the early 20th century, driven by biomedical advances and profound socio-cultural shifts worldwide, particularly in Spain. This expansion has enabled access to parenthood in previously inaccessible situations, such as infertility and diverse family structures, yet it also poses risks of human rights violations.

Materials and methods: A reflective analysis is conducted on the practices in Spanish healthcare related to assisted reproduction, based on national legislation and its alignment with international human rights legislation. The review of international standards was carried out using normative sources from the United Nations (UN), the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the World Health Organization (WHO), the Universal Declaration on Bioethics and Human Rights of UNESCO, and those adopted in the European regional context by the Council of Europe, particularly the Convention on Human Rights and Biomedicine.

Results: This article examines potential human rights violations within Spain's ART healthcare framework, identifying gaps in international human rights compliance. Despite Spain's progressive legislation on ART, discrepancies remain with evolving European standards, especially concerning oocyte donation and donor anonymity.

Conclusion: The goal is to promote reflection, improve the quality of care, and protect the health and rights of women, children, and families using ART, while ensuring that clinical practices align with human rights principles.

Comparison of the Depression Disorder and Related Psychosocial Disorders Before and After Contracting COVID-19 in Women Attending Imam Khomeini Hospital Complex

Mamak Shariat — 2025-08-01

Objective: The present study was conducted with the aim of comparing psychosocial disorders before and after contracting COVID-19 in women in the city of Tehran.

Materials and methods: A retrospective descriptive-analytical study was conducted on 250 women
who had recovered from COVID-19. The data were collected from the information registration system for COVID-19 patients in Tehran-Iran from the year 2019 until 2020. Data were collected using demographic questionnaires, The Hospital Anxiety and Depression Scale (HADS), The Billings and Moss Coping Strategies, Multidimensional Scale of Perceived Social Support (MSPSS), Mini-Mental State Examination (MMSE), Russell Loneliness Scale, Beck Scale for Suicide Ideation (BSSI), Female Sexual Function Index (FSFI), and Pittsburgh Sleep Quality Index (PSQI). Data analysis was performed using the analysis of covariance (ANCOVA). The SPSS-20 software was utilized for data analysis.

Results: The results obtained in this study indicated that women who had more severe COVID-19 reported higher levels of depression and cognitive disorders and lower sexual tendencies after recovery compared to women with mild COVID-19. There was a significant difference in disease severity (from mild to severe) in psychological variables such as sleep and sexual disorders, depression, social support, and cognition before and after recovery from COVID-19 (p=0.0001).

Conclusion: Due to severe fear and anxiety and other psychological disorders in people infected with Corona even after recovery from the disease, Psychologists should take measures for the relaxation and mental health of patients, such as consultations (online and by phone) for patients at home during quarantine, which will cause the patient to recover as quickly as possible and prevent mental disorders of the patients.

Progesterone Challenge Test in Screening of Endometrial Pathologic Lesions in High-Risk Post-Menopausal Women

Afsaneh Tehranian — 2025-08-01

Objective: This study aimed to evaluate the prognostic value of the progesterone challenge test (PCT) in the diagnosis of hyperplastic and cancerous endometrium in high-risk postmenopausal women.

Materials and methods: In this cross-sectional study, 72 postmenopausal women without abnormal uterine bleeding who had risk factors for endometrial cancer were recruited. Patients with endometrial thickness of 4 mm or more as determined transvaginal ultrasonography were tested with progesterone challenge test. If there were any bleeding (spotting to severe bleeding) in the next two weeks, the test would be considered positive. After two weeks, all of the participants despite the result of PCT underwent office endometrial biopsy. In the end, all the results of PCT were compared with endometrial biopsy results.

Results: The mean age of the participants was 57.7 ±8.15 years. The progesterone challenge test
was positive in 17 women (22%). Among the participants with positive progesterone challenge test, most of them show hyperplasia (62.5%) and 4.2% show endometrial cancer. According to the results, PCT had 37.5% accuracy, 20.8% sensitivity, 70.8 % specificity, 58.8% positive predictive value (PPV), and 30.9 % negative predictive value (NPV) for diagnosis of endometrial pathology.

Conclusion: We suggest that due to the unacceptable sensitivity and specificity of the PCT, this test alone is not suitable for screening of endometrial cancer or hyperplasia.

Assessment of Gene Expression on the Gap Junction Connexin of Cumulus Cells on Infertile Women With Polycystic Ovary Syndrome and Poor Ovarian Response: The Novel Role of Propranolol

Farideh Zafari Zangeneh — 2025-08-01

Objective: Building upon prior research, our investigation focused on examining changes in gene expression of Connexins 37 and 43 (Cx) influenced by β2-adrenergic agents in cumulus cell cultures from women with polycystic ovarian syndrome (PCOS) and poor ovarian response (POR), all of whom were candidates for in vitro fertilization (IVF).

Materials and methods: This experimental study was conducted between April 2021 and November 2023, involving three groups: a control group (donated eggs) and two study groups (POR and PCO). All three groups received ovulation stimulation drugs. Following oocyte puncture, cumulus cells (CCs) were isolated and placed in a culture medium. After three passages, CCs were exposed to the ADR-β2 agonist isoproterenol and its antagonist propranolol (100nM for both drugs). RNA extraction was performed, and cDNA was synthesized. Real-time PCR was used to determine gene expression, and protein levels were measured through the Western blotting method.

Results: The gene expression of Cx 37/43 was significantly reduced in all three groups (P<0.001). For women with PCO and POR, Isop notably decreased expressions (P<0.001), while Prop increased them (P<0.001). Western Blot results confirmed these findings.

Conclusion: The findings of this in-vitro study suggest that the beta-2 adrenergic antagonist propranolol could upregulate gene expression of Cx37/43 in the cellular connections of CCs among infertile women. Consequently, propranolol may enhance communication between CCs and oocytes, facilitating the transfer of signalling messengers and other essential agents required for oocyte development. This novel discovery could have significant implications for oocyte growth and maturation, offering valuable perspectives on drug treatment and assisted reproductive technology. This novel discovery could have significant implications for oocyte growth and maturation, offering valuable perspectives on drug treatment and assisted reproductive technology.

Lactobacilli Deficiency in Infertile Women Seeking IVF in Arash Hospital: An Imbalance in the Genital Microbiome

Anis Mohammadi — 2025-08-01

Objective: It is estimated that infertility affects approximately 9-30% of couples in their reproductive age and microorganisms may play an important role in such genital system dysfunction. The aim of this study was to investigate the presence of lactobacilli, Gardnerella, Enterobacteriaceae, and streptococci in the vagina, cervix and endometrium of women who referred for infertility and the healthy women who referred for oocyte donation.

Materials and methods: The endometrial, cervical and vaginal swab specimens were collected three days after the end of menstruation and cultured to isolate lactobacilli. DNA form these specimens was extracted and subjected to quantitative real-time PCR to determine the frequency of the above bacteria. All uterine biopsy samples were tested for the presence of bacterial DNA by PCR method.

Results: 94% of uterine biopsy samples contained bacterial DNA. The frequency of lactobacilli identified by real-time quantitative PCR in these two groups was 40% (endometrial samples), 70% (cervical samples), and 80% (vaginal samples), which differed from lactobacilli isolated by the culture method. The number of lactobacilli from cervical endometrium of healthy donors was higher than in the diseased group. There was a significant difference in the mean of Gardnerella bacteria in the cervix and endometrium and Streptococcus in the cervix (p<0.05).

Conclusion: Considering the decrease of lactobacilli and the increase of other bacteria, it is suggested to consider the composition and number of bacteria in the genital tract of asymptomatic infertile women as one of the possible causes of infertility.

Comparing the Effectiveness of Expressive Writing and Relaxation on Mental Health and Treatment Success in Women Undergoing Assisted Reproductive Technology: A Randomized Controlled Trial

Zahra Najdgholami — 2025-08-01

Objective: Infertility and its treatments can lead to mood disorders such as depression, anxiety, stress. This study aimed to compare the effects of relaxation and expressive writing on depression, anxiety, stress, and treatment success in women utilizing assisted reproductive technology methods.

Materials and methods: In this parallel randomized clinical controlled trial, 90 infertile women undergoing assisted reproductive technology were involved. Participants were randomly assigned to three groups: writing (n=30), relaxation (n=30), and control (n=30). The writing and relaxation groups received either expressive writing or relaxation interventions, while the control group only received routine treatment. The primary outcomes measured in the study were depression, anxiety, and stress, with treatment success as the secondary outcome. All participants completed the Depression, Anxiety, and Stress Scale at the beginning of the treatment cycle and again before ovarian puncture. Statistical analysis was performed using the Chi-squared, Kruskal-Wallis, and Wilcoxon tests. A p-value<0.05 was considered statistically significant.

Results: The results showed that mean differences in depression (P=0.001) and stress scores (P=0.011) before and after intervention in the writing group were significantly higher than in the control group. Additionally, only the writing group experienced a significant decrease in depression (P=0.016). However, there was no significant difference in other measured outcomes among the three groups.

Conclusion: It is recommended to conduct more well-designed studies to further investigate the effects of expressive writing and relaxation techniques.

Hospital Performance Indicators in Provision of Perinatal Services: A Qualitative Study

Hossein Jabbari Bayrami — 2025-08-01

Objective: Perinatal mortality is an indicating factor in social development, and international measures have been taken to reduce maternal and perinatal mortality. This study aims to collect the experts’ opinions about hospitals performance in providing perinatal services and emerge the key indicators for evaluation.

Materials and methods: This is a qualitative study using the Delphi technique and based on the focus group discussion sessions with twelve experts, including pediatricians, perinatologists, neonatologists, neonatal care nurses, and midwives with at least five years of work experience. A coordinator managed the sessions, and the discussions continued until saturation. Thematic analysis was performed to extract the major themes and sub-themes.

Results: Three main themes of input/structure, process, and outcome are extracted. The input/structure theme consists of human resources, physical space, equipment, and technical support and information. In human resources, the number and proficiency of healthcare providers and mental health problems are expressed. In terms of physical space, the areas and infrastructure facilities are discussed. The proper purchase and allocation of equipment are emphasized in the equipment sub-theme. The need to establish a Health Information Service in level-one centers is mentioned in the support sub-theme. The process theme consists of medical staff retraining and empowerment, referral, follow-up, education, and audits. The maternal and neonatal mortality and morbidity indices are cited in the outcome theme.

Conclusion: Our findings provide a wide range of context-specific challenges the healthcare systems face in provision of perinatal health services. As a result of this study, the primary indicators for assessing the hospitals’ performance in providing perinatal services are emerged.

Four Years' Experience at a Single Referral Center Regarding Urodynamic Findings in Women With Voiding Dysfunction

Zinat Ghanbari — 2025-08-01

Objective: This study aimed to evaluate the urodynamic findings in women with voiding dysfunction symptoms at a referral academic center.

Materials and methods: Patients who underwent urodynamics to evaluate voiding dysfunction symptoms between 2019 and 2022 were retrospectively analyzed. Demographic and clinical data were obtained from the electronic data registration system of the urogynecology clinic. Urodynamic findings, such as post-void residual (PVR), maximum urine flow (Q max), detrusor pressure (P det), abdominal leak point pressure (ALPP), and detrusor overactivity, as well as their association with each symptom of voiding dysfunction, were analyzed and reported.

Results: A total of 591 women were enrolled in the study, with a mean age of 54.09±12.3 years. The majority had experienced vaginal deliveries (82.9%). The most frequently reported symptom was incomplete voiding (71.1%), followed by post-void dribbling, intermittent stream and others. Post-void residual (PVR) >150 cc was identified in 2.7% of patients and was significantly associated with hesitancy and straining to void. It was also associated with increasing age and anterior and apical compartment prolapse.

Conclusion: Voiding dysfunction symptoms do not reliably predict urodynamic findings. The low prevalence of post-void residual (PVR) in symptomatic patients and the lack of correlation between PVR and similar symptoms suggest that symptoms alone may not provide adequate evidence to indicate high PVR. Therefore, urodynamics may be necessary for evaluating patients with voiding dysfunction symptoms.

Relationship between Vitamin D Level and DNA Fragmentation Index of Sperm in Men Referred to Omid Infertility Center in Hamadan-Iran: A Cross-Sectional Study

Mohamadnabi Holakouie Naini — 2025-08-01

Objective: Unfortunately, the prevalence of infertility in Iran and the world is increasing. There is limited research on the relationship between vitamin D and DNA fragmentation index (DFI). DFI is a measure of DNA damage in sperm cells and is used to evaluate male fertility. Some studies suggest that vitamin D may play a role in sperm health and fertility.

Materials and methods: In this cross-sectional study, 789 eligible men referred to the Omid Infertility Clinic in Hamadan-Iran in 2021-2023. Serum levels of vitamin D, DFI, spermogram indexes and demographic characteristics (occupation, age, and body mass index) were collected by face-to-face interview and records review in case files. Data were analyzed with SPSS version 27 software.

Results: There is no significant relationship between DFI and vitamin D before and after removing the effect of confounding variables. Clearly, increasing age has been associated with increasing (DFI 95%
Cl: 1.06-3.03; p<0.05) odds ratio (OR) = 1.79. The relationship between the increase in DFI and the decrease in normal sperm morphology (95% CI: 1.43-4.20; p<0.01) OR = 2.45 and the decrease in the progressive motility of sperm was seen (95% Cl: 1.66-4.87; p<0.05) OR= 2.85 and also. The relationship between DFI and the decrease in sperm count after removing the effect Confounding variables were observed (95%Cl: 1.06-8.38; p<0.05) OR=2.98.

Conclusion: No correlation between DFI and vitamin D serum level was found. However, a clear association was observed between increased DFI and advanced age, reduced progressive motility, abnormal sperm morphology, and decreased sperm count.